One Boeing 757 Crashing Every Day.
December 14, 2022 4:20 PM Subscribe
How bad is the fentanyl crisis in America? Very bad. " 'The cartels saw the void left by the U.S. pharmaceutical industry,' said John Callery, a 30-year veteran of the DEA who retired after running the San Diego field office. 'Nature abhors a vacuum and they said, ‘Holy crap. We only have to get five pounds of fentanyl across the border instead of 7,000 pounds of meth. Perfect. And we can make 10 times as much money.’”'"
The article covers the DEA's confused and unfocussed response, the rise of the Mexican cartel supply chain and the situation in San Diego, ground zero for fetanyl smuggling.
"The American fentanyl crisis deepened during the coronavirus pandemic. From 2019 to 2021, fatal overdoses surged 94 percent, and an estimated 196 Americans are now dying each day from the drug — the equivalent of a fully loaded Boeing 757-200 crashing and killing everyone on board."
"The American fentanyl crisis deepened during the coronavirus pandemic. From 2019 to 2021, fatal overdoses surged 94 percent, and an estimated 196 Americans are now dying each day from the drug — the equivalent of a fully loaded Boeing 757-200 crashing and killing everyone on board."
Great series in the WaPo, and very important. But they’re identical to the articles written 30 years ago about heroin. And they do not really get into the issue of why so many people are buying the drugs in the first place.
posted by Melismata at 4:37 PM on December 14, 2022 [18 favorites]
posted by Melismata at 4:37 PM on December 14, 2022 [18 favorites]
“Law enforcement did the best it could,” said David King, executive director of a federal drug task force in San Diego. “We can only do so much. But in Washington, they have been very slow to respond to this and now we are at the confluence of paralysis.”
Prohibition isn't the answer. "Law enforcement" isn't the answer. Safe, legal supply of opiates is. Full stop.
One of Byrne’s problems was that no one else wanted to test for fentanyl at crime scenes. In the early stages of the crisis, much of the DEA messaging had been geared toward alerting first responders to the dangers of fentanyl. They became so terrified that they would call in hazmat crews if they thought fentanyl was present.
But Byrne saw the downside to the scary messaging. Fentanyl is only a significant threat if the powder is dispersed into the air and inhaled. Touching the pills or handling bags of powder is not a mortal risk because the drug isn’t easily absorbed through the skin. Pharmaceutical fentanyl “patches” prescribed to manage intense pain use a chemical agent to allow the drug to be absorbed.
"Scary messaging" about drug use has never, ever helped fentanyl or not. It's the basis for the War on [Some] Drugs, and it gets people killed.
The degree and depth of copaganda around "OMG you can OD on fentanyl by touching it!" continues unabated. It's an epidemic unto itself, and it's bullshit...
Ryan Marino, MD (Twitter link):
I wrote this if you want to know actual facts like:
-how fentanyl works
-why you can’t OD from accidental exposure to fentanyl
-real risks of fentanyl
-how to actually prevent fentanyl overdose
-how misinformation like the “exposure” myth causes real harms
Here's what Marino wrote:
Fear, Loathing, and Fentanyl Misinformation — Misleading fentanyl narratives are pervasive and cause very real harm.
His article cites outright lies -- published and unretracted by the Washington Post, among other media outlets -- about law enforcement "overdoses" (which were not) by casually being in the presence of suspected fentanyl.
posted by mandolin conspiracy at 4:50 PM on December 14, 2022 [55 favorites]
Prohibition isn't the answer. "Law enforcement" isn't the answer. Safe, legal supply of opiates is. Full stop.
One of Byrne’s problems was that no one else wanted to test for fentanyl at crime scenes. In the early stages of the crisis, much of the DEA messaging had been geared toward alerting first responders to the dangers of fentanyl. They became so terrified that they would call in hazmat crews if they thought fentanyl was present.
But Byrne saw the downside to the scary messaging. Fentanyl is only a significant threat if the powder is dispersed into the air and inhaled. Touching the pills or handling bags of powder is not a mortal risk because the drug isn’t easily absorbed through the skin. Pharmaceutical fentanyl “patches” prescribed to manage intense pain use a chemical agent to allow the drug to be absorbed.
"Scary messaging" about drug use has never, ever helped fentanyl or not. It's the basis for the War on [Some] Drugs, and it gets people killed.
The degree and depth of copaganda around "OMG you can OD on fentanyl by touching it!" continues unabated. It's an epidemic unto itself, and it's bullshit...
Ryan Marino, MD (Twitter link):
I wrote this if you want to know actual facts like:
-how fentanyl works
-why you can’t OD from accidental exposure to fentanyl
-real risks of fentanyl
-how to actually prevent fentanyl overdose
-how misinformation like the “exposure” myth causes real harms
Here's what Marino wrote:
Fear, Loathing, and Fentanyl Misinformation — Misleading fentanyl narratives are pervasive and cause very real harm.
His article cites outright lies -- published and unretracted by the Washington Post, among other media outlets -- about law enforcement "overdoses" (which were not) by casually being in the presence of suspected fentanyl.
posted by mandolin conspiracy at 4:50 PM on December 14, 2022 [55 favorites]
Today would have been the 43rd birthday of my dear friend who died of a fentanyl overdose last year. She had been buying counterfeit Vicodin off the street. Not sure how you stop deaths like hers by legalizing recreational drugs.
posted by rhymedirective at 4:53 PM on December 14, 2022 [13 favorites]
posted by rhymedirective at 4:53 PM on December 14, 2022 [13 favorites]
I had a close friend die, alone, of a fentanyl OD a week and a half ago. If he had been able to purchase legal opioids that were manufactured and sold according to the same standards as alcohol, weed or Tylenol he would still be alive. Maybe.
posted by kittensofthenight at 5:14 PM on December 14, 2022 [25 favorites]
posted by kittensofthenight at 5:14 PM on December 14, 2022 [25 favorites]
I feel like an idiot here, but there’s something really fundamental I don’t understand. Why are they using fentanyl to cut other drugs? It’s cheaper than the drug, but certainly there must be something inert that’s even cheaper. Like in the case of rhymedirective’s friend. Vicodin isn’t even the same class of drug. And they’re making a counterfeit that might kill the customer?
I could understand if it were just to keep opiate addicts addicted (but even then…. Get the dosing sane?) But cutting it into MDMA and cocaine and ketamine and barbiturates? Why?
That’s not a rhetorical why. I really don’t understand, and none of the journalism around this has been clear.
posted by mr_roboto at 5:19 PM on December 14, 2022 [9 favorites]
I could understand if it were just to keep opiate addicts addicted (but even then…. Get the dosing sane?) But cutting it into MDMA and cocaine and ketamine and barbiturates? Why?
That’s not a rhetorical why. I really don’t understand, and none of the journalism around this has been clear.
posted by mr_roboto at 5:19 PM on December 14, 2022 [9 favorites]
mr_roboto: i'm not a pharmacist, but vicodin and fentanyl are indeed both opioids -- just like vicodin and percocet / oxycontin / whatever will do the trick of making you not have withdrawals.
posted by capnsue at 5:26 PM on December 14, 2022
posted by capnsue at 5:26 PM on December 14, 2022
Couldn't read the article because paywalled.
In the professional circles I run in, which had lots of interaction with substance use, word on the ground is that the percentage of street opioids sold are now more likely to have fentanyl than not. This (chicago tribune) article is following work done by CDPH and Chicago Recovery Alliance and the stats are startling about 88% 2021 of overdose deaths here can be attributed to Fentenyl.
In my work I've seen changes in how linkage to MAT works (lowering barriers to entry to get started) and improving access to Naloxone in Chicago. Though there is so much more work to be done. Here there is also danger of frostbite to those who use and OD outside, and the results can be devastating.
I'm really hoping for for better legal access, and safe injection sites New York city opened one about 2 years ago.
posted by AlexiaSky at 5:30 PM on December 14, 2022 [8 favorites]
In the professional circles I run in, which had lots of interaction with substance use, word on the ground is that the percentage of street opioids sold are now more likely to have fentanyl than not. This (chicago tribune) article is following work done by CDPH and Chicago Recovery Alliance and the stats are startling about 88% 2021 of overdose deaths here can be attributed to Fentenyl.
In my work I've seen changes in how linkage to MAT works (lowering barriers to entry to get started) and improving access to Naloxone in Chicago. Though there is so much more work to be done. Here there is also danger of frostbite to those who use and OD outside, and the results can be devastating.
I'm really hoping for for better legal access, and safe injection sites New York city opened one about 2 years ago.
posted by AlexiaSky at 5:30 PM on December 14, 2022 [8 favorites]
(FWIW mr_roboto i also do not understand why killing your customers is a good idea tho..."get the dosing sane" i think is why a lot of people are in favor of legalization)
posted by capnsue at 5:32 PM on December 14, 2022 [1 favorite]
posted by capnsue at 5:32 PM on December 14, 2022 [1 favorite]
i'm not a pharmacist, but vicodin and fentanyl are indeed both opioids
You’re right. I was thinking for some reason that Vicodin was a benzo. Obviously not. Sorry for the confusion.
posted by mr_roboto at 5:34 PM on December 14, 2022
You’re right. I was thinking for some reason that Vicodin was a benzo. Obviously not. Sorry for the confusion.
posted by mr_roboto at 5:34 PM on December 14, 2022
legalize all drugs
legalize all drugs
legalize all drugs
legalize all drugs
legalize all drugs
legalize all drugs
legalize all drugs
posted by cubeb at 5:37 PM on December 14, 2022 [15 favorites]
legalize all drugs
legalize all drugs
legalize all drugs
legalize all drugs
legalize all drugs
legalize all drugs
posted by cubeb at 5:37 PM on December 14, 2022 [15 favorites]
I'm so sorry, rhymedirective and kittensofthenight. Nobody should be dying like that. It's all so fucked up.
Fentanyl is cheap, potent, and wildly compact by weight and volume. In a black market scenario, it makes absolute (twisted) sense.
"Safe and legal supply" of drugs isn't some kind of magical solution. It's ONLY a starting point.
PSA, for people in Canada: Opioid Response Training for Individuals via St. John Ambulance will get you a training session and they'll send you naloxone kits.
posted by mandolin conspiracy at 5:40 PM on December 14, 2022 [6 favorites]
Fentanyl is cheap, potent, and wildly compact by weight and volume. In a black market scenario, it makes absolute (twisted) sense.
"Safe and legal supply" of drugs isn't some kind of magical solution. It's ONLY a starting point.
PSA, for people in Canada: Opioid Response Training for Individuals via St. John Ambulance will get you a training session and they'll send you naloxone kits.
posted by mandolin conspiracy at 5:40 PM on December 14, 2022 [6 favorites]
The cartels may be acting like pharmaceutical companies, but they aren’t pharmacologists and cutting drugs with fentanyl is just bad medicine. On the other hand, pharmaceutical companies here in the US, as well as pharmacy companies, were the root source of the opioid plague here. They should have known better. But both them and the cartels are just doing this for the money. And none of the people in the pharmaceutical companies or pharmacies involved here in the pushing of these drugs is facing any threat of arrest. The so-called war on drugs has been a total failure since it started in the 30’s. These deaths are also the fault of the government in its failure to actually treat the real medical problem we have. Here in San Francisco they just shut down the safe injection site, which was actually doing some good, because the mayor is having issues about its legality. People are dying and the politicians are playing their stupid games, which is probably also all about the money.
posted by njohnson23 at 5:47 PM on December 14, 2022 [9 favorites]
posted by njohnson23 at 5:47 PM on December 14, 2022 [9 favorites]
But they’re identical to the articles written 30 years ago about heroin.
I am very anti-opioid scaremongering, but the meaningful difference here is the number of what you might call qualitative overdoses: people who thought they were buying something else--sometimes not even opioids!--and got something contaminated with fentanyl, as opposed to people who bought themselves an inappropriate dose of heroin, or deliberately mixed percs and pins, etc. It seems like a supremely dangerous time to be a user of street drugs.
I've long been skeptical of the deliberate cutting theory (there's got to be an economic upper limit to your willingness to kill your customers over a very short period), but I guess, in addition to the usual problems of the wildly unreliable supply chain, fentanyl is so damn cheap and plentiful now that someone along the way is liable to give way to the temptation to give the package a little extra kick.
I've said this before, though: I know someone who was a damn pioneer of fentanyl addiction--they were chewing Duragesic patches back in the 90s--but died past retirement, of lung cancer probably from their long-abandoned but entirely legal tobacco use, because they had just enough knowledge and status to get themselves a reasonably safe supply to maintain on. So many of these deaths are socially determined rather than an inevitable consequence of using.
posted by praemunire at 6:10 PM on December 14, 2022 [12 favorites]
I am very anti-opioid scaremongering, but the meaningful difference here is the number of what you might call qualitative overdoses: people who thought they were buying something else--sometimes not even opioids!--and got something contaminated with fentanyl, as opposed to people who bought themselves an inappropriate dose of heroin, or deliberately mixed percs and pins, etc. It seems like a supremely dangerous time to be a user of street drugs.
I've long been skeptical of the deliberate cutting theory (there's got to be an economic upper limit to your willingness to kill your customers over a very short period), but I guess, in addition to the usual problems of the wildly unreliable supply chain, fentanyl is so damn cheap and plentiful now that someone along the way is liable to give way to the temptation to give the package a little extra kick.
I've said this before, though: I know someone who was a damn pioneer of fentanyl addiction--they were chewing Duragesic patches back in the 90s--but died past retirement, of lung cancer probably from their long-abandoned but entirely legal tobacco use, because they had just enough knowledge and status to get themselves a reasonably safe supply to maintain on. So many of these deaths are socially determined rather than an inevitable consequence of using.
posted by praemunire at 6:10 PM on December 14, 2022 [12 favorites]
The reason why fentanyl shows up in other drugs is cross contamination. It's potency per unit mass is so great that enough of it can contaminate other drugs being cut/ packaged that someone without opioid tolerance can get a dose enough to cause respiratory failure.
A contributing reason why there are so many fent overdoses is that drug dealers are shit at compounding - if you don't grind finely enough before pressing pills/ aliquoting, the dose-to-dose variation is enough that even if someone has strong opioid tolerance can still end up with a toxic dose.
Also, people using "clean drugs" or were tapering or had quit - tolerance falls. In the early days of the fent epidemic in Vancouver, a lot of users didn't know they were getting fent and so on visual inspection it looks like a 'regular' dose, but they end up with more and more potent drug than they are used to.
posted by porpoise at 6:11 PM on December 14, 2022 [10 favorites]
A contributing reason why there are so many fent overdoses is that drug dealers are shit at compounding - if you don't grind finely enough before pressing pills/ aliquoting, the dose-to-dose variation is enough that even if someone has strong opioid tolerance can still end up with a toxic dose.
Also, people using "clean drugs" or were tapering or had quit - tolerance falls. In the early days of the fent epidemic in Vancouver, a lot of users didn't know they were getting fent and so on visual inspection it looks like a 'regular' dose, but they end up with more and more potent drug than they are used to.
posted by porpoise at 6:11 PM on December 14, 2022 [10 favorites]
In the early days of the fent epidemic in Vancouver, a lot of users didn't know they were getting fent and so on visual inspection it looks like a 'regular' dose, but they end up with more and more potent drug than they are used to.
This happens even without contamination, though--people misjudge their tolerance after rehab. The early relapse period is super dangerous, too.
posted by praemunire at 6:13 PM on December 14, 2022 [2 favorites]
This happens even without contamination, though--people misjudge their tolerance after rehab. The early relapse period is super dangerous, too.
posted by praemunire at 6:13 PM on December 14, 2022 [2 favorites]
On the plus side if you shout “fentanyl” real loud at a cop they drop unconscious.
posted by Artw at 6:17 PM on December 14, 2022 [49 favorites]
posted by Artw at 6:17 PM on December 14, 2022 [49 favorites]
NZ saw one import of supposedly cocaine that turned out to be fentanyl. Why? Coz it's cheaper and a smaller package therefore more profitable and less risky to import.
That one package put 13 people in hospital. We were very close to multiple fatalities. Because we have drug checking, we could identify and respond to that very rapidly. If we'd had widespread drug checking then that one package could have been tested before anyone consumed it.
And if we had legal and controlled supply, then the people who wanted to buy cocaine would not have been delivered fentanyl. What they bought would be of a guaranteed quality. They would avoid any risks from substitution, impurities, or mis-representation. Just like when people by other chemcials, whether medicine, alcohol, or food supplements.
posted by happyinmotion at 6:20 PM on December 14, 2022 [10 favorites]
That one package put 13 people in hospital. We were very close to multiple fatalities. Because we have drug checking, we could identify and respond to that very rapidly. If we'd had widespread drug checking then that one package could have been tested before anyone consumed it.
And if we had legal and controlled supply, then the people who wanted to buy cocaine would not have been delivered fentanyl. What they bought would be of a guaranteed quality. They would avoid any risks from substitution, impurities, or mis-representation. Just like when people by other chemcials, whether medicine, alcohol, or food supplements.
posted by happyinmotion at 6:20 PM on December 14, 2022 [10 favorites]
She had been buying counterfeit Vicodin off the street. Not sure how you stop deaths like hers by legalizing recreational drugs.
I do not mean this to come off as snark but I feel like I’m misreading something here. You are laying out the textbook case for legalizing drugs - it’s better for people to be taking the real thing than counterfeits off the street.
posted by atoxyl at 6:22 PM on December 14, 2022 [23 favorites]
I do not mean this to come off as snark but I feel like I’m misreading something here. You are laying out the textbook case for legalizing drugs - it’s better for people to be taking the real thing than counterfeits off the street.
posted by atoxyl at 6:22 PM on December 14, 2022 [23 favorites]
risks from substitution, impurities, or mis-representation
I've paged through a few textbooks on industrial powder mixing, and mixing two powders to a set degree of homogeneity mathematically requires a minimum amount of energy, and when it's a micro or nano powder that amount of energy rises exponentially.
I saw a TV documentary that showed a fentanyl dealer stirring in the cut with a teaspoon in a coffee cup, guaranteeing a wide range of inhomogeneity. Pure fentanyl is super potent, but it's not sold that way, it's supposed to be cut to a blended consistency at a specific strength.
There's no motivation to sell something stronger than wanted. I think the biggest cause of overdoses is not so much the strength of fentanyl per se, but rather ignorance on the part of dealers about how to achieve a proper homogeneous mixture at the micro and nano scale. Just sayin.
posted by StickyCarpet at 6:34 PM on December 14, 2022 [8 favorites]
I've paged through a few textbooks on industrial powder mixing, and mixing two powders to a set degree of homogeneity mathematically requires a minimum amount of energy, and when it's a micro or nano powder that amount of energy rises exponentially.
I saw a TV documentary that showed a fentanyl dealer stirring in the cut with a teaspoon in a coffee cup, guaranteeing a wide range of inhomogeneity. Pure fentanyl is super potent, but it's not sold that way, it's supposed to be cut to a blended consistency at a specific strength.
There's no motivation to sell something stronger than wanted. I think the biggest cause of overdoses is not so much the strength of fentanyl per se, but rather ignorance on the part of dealers about how to achieve a proper homogeneous mixture at the micro and nano scale. Just sayin.
posted by StickyCarpet at 6:34 PM on December 14, 2022 [8 favorites]
Fentanyl in other drugs is probably cross contamination in the majority of cases but with things like benzos in particular maybe occasionally somebody has the bright idea of giving something an extra kick.
In the professional circles I run in, which had lots of interaction with substance use, word on the ground is that the percentage of street opioids sold are now more likely to have fentanyl than not.
It’s worth noting that people do knowingly buy illicit fentanyl as well. When longtime opioid users buy the blue-green “M30” pills, available everywhere - which are modeled on one of the classic generics for 30mg oxycodone, but which are nowadays 99 percent of the time mass-produced fentanyl pills - trust me that they generally know what they’re looking for, though they are still at risk from uneven potency and poor quality control and a whole range of possible active ingredients. But there are plenty of cases of novice or casual users trying to buy “percs” with swiftly tragic results.
posted by atoxyl at 6:36 PM on December 14, 2022 [1 favorite]
In the professional circles I run in, which had lots of interaction with substance use, word on the ground is that the percentage of street opioids sold are now more likely to have fentanyl than not.
It’s worth noting that people do knowingly buy illicit fentanyl as well. When longtime opioid users buy the blue-green “M30” pills, available everywhere - which are modeled on one of the classic generics for 30mg oxycodone, but which are nowadays 99 percent of the time mass-produced fentanyl pills - trust me that they generally know what they’re looking for, though they are still at risk from uneven potency and poor quality control and a whole range of possible active ingredients. But there are plenty of cases of novice or casual users trying to buy “percs” with swiftly tragic results.
posted by atoxyl at 6:36 PM on December 14, 2022 [1 favorite]
On the plus side if you shout “fentanyl” real loud at a cop they drop unconscious.
That's nothing, I heard 14 cops were sent to the hospital by a guy who thought the word too loud.
posted by praemunire at 6:36 PM on December 14, 2022 [20 favorites]
That's nothing, I heard 14 cops were sent to the hospital by a guy who thought the word too loud.
posted by praemunire at 6:36 PM on December 14, 2022 [20 favorites]
There are always people using drugs for recreational reasons but most of the people I've met were self-medicating when the system failed them; no access to regular healthcare, being forced off opioids despite chronic pain, untreated or hard-to-treat mental illness. If you're wondering why anyone would take such risks for a high. Imagine being in agonizing pain and no one will or can help you. At a certain point, you would do anything to make it stop, damn the risks.
posted by emjaybee at 6:36 PM on December 14, 2022 [19 favorites]
posted by emjaybee at 6:36 PM on December 14, 2022 [19 favorites]
I do not mean this to come off as snark but I feel like I’m misreading something here. You are laying out the textbook case for legalizing drugs - it’s better for people to be taking the real thing than counterfeits off the street.
I knew it was going to be a mistake to share that and I’m sorry that I did.
I’m not really interested in going into the 25 year history of my friendship and my friend’s life. But suffice it to say, no, legalized street drugs would not have saved her life.
posted by rhymedirective at 6:43 PM on December 14, 2022 [7 favorites]
I knew it was going to be a mistake to share that and I’m sorry that I did.
I’m not really interested in going into the 25 year history of my friendship and my friend’s life. But suffice it to say, no, legalized street drugs would not have saved her life.
posted by rhymedirective at 6:43 PM on December 14, 2022 [7 favorites]
I really do not appreciate the anti-cop sentiment around here.
posted by Melismata at 6:46 PM on December 14, 2022 [6 favorites]
posted by Melismata at 6:46 PM on December 14, 2022 [6 favorites]
This happens even without contamination
Not just. In the early-ish days, fent was so much easier to smuggle that the real heroine supply plummeted to nothing. Only fent was available.
After a while, heavy users got used to the high that shittier drugs gave them. Made heroine boring, and methadone less than useless.
I can see myself dying to opioids if I had to endure the conditions that the homeless/ underhoused have to, and all the other people's failing/ mal-adapted mental health echoing around and making everyone so much more miserable.
The new Premiere (inherited the position, has contradictory history) is pushing for legislation allowing the forced rehab and forced mental health treatment for the worst offenders/ most frequently overdosed. There are people who get revived with naloxone 3 times in the span of 24 hours.
posted by porpoise at 6:48 PM on December 14, 2022
Not just. In the early-ish days, fent was so much easier to smuggle that the real heroine supply plummeted to nothing. Only fent was available.
After a while, heavy users got used to the high that shittier drugs gave them. Made heroine boring, and methadone less than useless.
I can see myself dying to opioids if I had to endure the conditions that the homeless/ underhoused have to, and all the other people's failing/ mal-adapted mental health echoing around and making everyone so much more miserable.
The new Premiere (inherited the position, has contradictory history) is pushing for legislation allowing the forced rehab and forced mental health treatment for the worst offenders/ most frequently overdosed. There are people who get revived with naloxone 3 times in the span of 24 hours.
posted by porpoise at 6:48 PM on December 14, 2022
It's possible to simultaneously believe the DEA sometimes lies, that cops have exaggerated the danger of fentanyl exposure, and that fentanyl is a serious danger to drug users who are at severe risk of overdosing because of sloppy adulteration and the very tiny amount of dosage required to kill you. All these things can be true at once.
posted by Nelson at 7:02 PM on December 14, 2022 [28 favorites]
posted by Nelson at 7:02 PM on December 14, 2022 [28 favorites]
I really do not appreciate the anti-cop sentiment around here.
Tell them not to be ridiculous drama queens who lie all the time then.
posted by Artw at 7:24 PM on December 14, 2022 [54 favorites]
Tell them not to be ridiculous drama queens who lie all the time then.
posted by Artw at 7:24 PM on December 14, 2022 [54 favorites]
I really do not appreciate the pro-cop sentiment around here.
posted by evilDoug at 7:27 PM on December 14, 2022 [55 favorites]
posted by evilDoug at 7:27 PM on December 14, 2022 [55 favorites]
In fairness ridiculously compliant local media who spread their obviously untrue stories of ODing after coming into contact with random objects are also part of the problem.
posted by Artw at 7:30 PM on December 14, 2022 [7 favorites]
posted by Artw at 7:30 PM on December 14, 2022 [7 favorites]
Mod note: Lets please drop the pro/anti cop comments
posted by travelingthyme (staff) at 7:38 PM on December 14, 2022 [10 favorites]
posted by travelingthyme (staff) at 7:38 PM on December 14, 2022 [10 favorites]
I knew it was going to be a mistake to share that and I’m sorry that I did.
I’m not really interested in going into the 25 year history of my friendship and my friend’s life. But suffice it to say, no, legalized street drugs would not have saved her life.
I meant it when I said I wasn’t trying to be an asshole about it. I have strong feelings of my own because I’m responding as a former street drug user (which means it almost goes without saying that I have also lost friends to drugs). And by no means do I think legalization solves every problem of drug addiction. But the way you told the story doesn’t really say what you’re trying to say about the legalization argument, so all I could really say was “I’m not sure what you’re getting at.” Sorry for the terse response, and sorry about your friend.
posted by atoxyl at 7:49 PM on December 14, 2022 [15 favorites]
I’m not really interested in going into the 25 year history of my friendship and my friend’s life. But suffice it to say, no, legalized street drugs would not have saved her life.
I meant it when I said I wasn’t trying to be an asshole about it. I have strong feelings of my own because I’m responding as a former street drug user (which means it almost goes without saying that I have also lost friends to drugs). And by no means do I think legalization solves every problem of drug addiction. But the way you told the story doesn’t really say what you’re trying to say about the legalization argument, so all I could really say was “I’m not sure what you’re getting at.” Sorry for the terse response, and sorry about your friend.
posted by atoxyl at 7:49 PM on December 14, 2022 [15 favorites]
Why are they using fentanyl to cut other drugs? It’s cheaper than the drug, but certainly there must be something inert that’s even cheaper.
Well the difference between cutting heroin with baby formula and fentanyl is that the baby formula doesn't do anything. Sure, you can use it to stretch out whatever actual diacetylmorphine you have on hand volumetrically, but it's nothing more than an inert (hopefully near-sterile) filler.
Fentanyl, by contrast, is a really powerful opioid. Which, if you were to mix it very precisely with the right amount of inert filler, could probably be a pretty good dose-for-dose replacement for heroin. I mean, that's literally how it's used in hospitals. They don't give actual diacetylmorphine very often, but they do use fentanyl, and it has basically the same effect as long as you do the dilution right. The problem is that because smuggled fentanyl is much more potent, gram for gram, than heroin, you have to have much more precise measuring equipment, which I can only presume—from the number of overdoses that have occurred—most drug dealers don't have.
Incidentally, this isn't anything new: decades ago, "China white", better known to people with PhDs as α-Methylfentanyl, was being sold as ersatz heroin. It killed a bunch of people in the 80s, and (from my perspective) seemingly disappeared for a while, for reasons I don't clearly understand. Perhaps Purdue Pharma had something to do with it.
AFAICT, there was a "first wave" of opiate overdoses due to "heroin" that was either contaminated with poorly-mixed fentanyl, or wasn't heroin at all, but actually fentanyl mixed with inert cutting agents to approximate (by definition poorly, if you ended up dead) the potency of heroin.
But despite the US's general contempt for recreational drug users of any type, consumers weren't stupid, and at some point demand for fentanyl-laced heroin must have declined. At least in my experience as an EMT, there was sort of a lull in overdoses for a while (and an uptick in "drug seeking" hospital patients, probably not coincidental).
From what I can infer, it seems that the drug importers responded to the increase in overdoses by no longer pushing pure fentanyl all the way down to street-level dealers. Perhaps reasoning (correctly) that the average numbskull street dealer working for sub-minimum wage was unprepared to deal with what amounts to a chemical weapon agent, they started bringing the stuff to labs in the US for cutting and processing before distribution. Intriguingly, this could be categorized as a sort of "market-based harm reduction", if you squint at it a bit. (And part of my general argument that over time, the cartels have probably saved more American lives than the DEA. It's just good business for them, while the DEA has no such incentive.)
The end product of these facilities (which can range greatly in sophistication) are pressed pills of approximately the same size and shape as prescription Oxy from Purdue et al. But because they definitely aren't actual Purdue Pharma oxy, and discerning opiate users know that rather well, they sell at a rather significant discount.
At least in some markets these ersatz Oxy pills were sometimes called "skittles", although I don't know how widespread or regional that term is. But I have heard it, almost always derisively, to refer to synthetic-opiate pills made to look like prescription opiates.
Should you venture onto the dark web—which I do not suggest you do, but is the sort of thing that can happen with enough boredom and bourbon—it's interesting to note that most of the drug markets have taken a hard stance against "skittles" and other fentanyl and synthetic-opiate analogs. Once again, the usually-brutal hand of the market shows more compassion than that of our government: if you sell drugs, dead customers are bad for business; if you're the DEA, they're a justification for your continued existence.
posted by Kadin2048 at 9:05 PM on December 14, 2022 [20 favorites]
Well the difference between cutting heroin with baby formula and fentanyl is that the baby formula doesn't do anything. Sure, you can use it to stretch out whatever actual diacetylmorphine you have on hand volumetrically, but it's nothing more than an inert (hopefully near-sterile) filler.
Fentanyl, by contrast, is a really powerful opioid. Which, if you were to mix it very precisely with the right amount of inert filler, could probably be a pretty good dose-for-dose replacement for heroin. I mean, that's literally how it's used in hospitals. They don't give actual diacetylmorphine very often, but they do use fentanyl, and it has basically the same effect as long as you do the dilution right. The problem is that because smuggled fentanyl is much more potent, gram for gram, than heroin, you have to have much more precise measuring equipment, which I can only presume—from the number of overdoses that have occurred—most drug dealers don't have.
Incidentally, this isn't anything new: decades ago, "China white", better known to people with PhDs as α-Methylfentanyl, was being sold as ersatz heroin. It killed a bunch of people in the 80s, and (from my perspective) seemingly disappeared for a while, for reasons I don't clearly understand. Perhaps Purdue Pharma had something to do with it.
AFAICT, there was a "first wave" of opiate overdoses due to "heroin" that was either contaminated with poorly-mixed fentanyl, or wasn't heroin at all, but actually fentanyl mixed with inert cutting agents to approximate (by definition poorly, if you ended up dead) the potency of heroin.
But despite the US's general contempt for recreational drug users of any type, consumers weren't stupid, and at some point demand for fentanyl-laced heroin must have declined. At least in my experience as an EMT, there was sort of a lull in overdoses for a while (and an uptick in "drug seeking" hospital patients, probably not coincidental).
From what I can infer, it seems that the drug importers responded to the increase in overdoses by no longer pushing pure fentanyl all the way down to street-level dealers. Perhaps reasoning (correctly) that the average numbskull street dealer working for sub-minimum wage was unprepared to deal with what amounts to a chemical weapon agent, they started bringing the stuff to labs in the US for cutting and processing before distribution. Intriguingly, this could be categorized as a sort of "market-based harm reduction", if you squint at it a bit. (And part of my general argument that over time, the cartels have probably saved more American lives than the DEA. It's just good business for them, while the DEA has no such incentive.)
The end product of these facilities (which can range greatly in sophistication) are pressed pills of approximately the same size and shape as prescription Oxy from Purdue et al. But because they definitely aren't actual Purdue Pharma oxy, and discerning opiate users know that rather well, they sell at a rather significant discount.
At least in some markets these ersatz Oxy pills were sometimes called "skittles", although I don't know how widespread or regional that term is. But I have heard it, almost always derisively, to refer to synthetic-opiate pills made to look like prescription opiates.
Should you venture onto the dark web—which I do not suggest you do, but is the sort of thing that can happen with enough boredom and bourbon—it's interesting to note that most of the drug markets have taken a hard stance against "skittles" and other fentanyl and synthetic-opiate analogs. Once again, the usually-brutal hand of the market shows more compassion than that of our government: if you sell drugs, dead customers are bad for business; if you're the DEA, they're a justification for your continued existence.
posted by Kadin2048 at 9:05 PM on December 14, 2022 [20 favorites]
From what I can infer, it seems that the drug importers responded to the increase in overdoses by no longer pushing pure fentanyl all the way down to street-level dealers.
In my understanding - can’t give citations here, this is a little bit of a “hanging out in the right places to see things come together” thing - the beginnings of the current fentanyl era are actually somewhat tied to the dark web and the “research chemical” scene. Back in the 90s and 00s “RCs” were mostly psychedelics, but towards the late 00s there was a huge boom in grey market stimulants (most famously mephedrone and the whole family of “bath salts”) synthetic cannabinoids (spice) etc. sold over the internet, and then in gas stations and head shops and the like. In this boom era, the drugs were mostly sourced from Chinese chemical companies that were happy to whip up a batch of whatever without asking too many questions, and resold by various vendors. Inevitably some people realized they could take advantage of this globalized on-demand designer drug infrastructure that had been built up to order fentanyl derivatives, worth a hundred times their weight in heroin and (presumably) get rich.
China eventually cracked down on direct manufacture and sale of synthetic opioids, while continuing to turn somewhat of a blind eye to precursors, and meanwhile the advantages of fentanyl as a product didn’t escape the notice of the Latin American cartels, so eventually the ecosystem shifted to one in which the cartels buy the precursors, make the drugs, and smuggle them for sale the traditional way. And also meanwhile the U.S. cracked down hard on prescription pills, use of which had been creeping up for two decades at that point, and illicit fentanyl use and overdoses took off in a matter of a few years.
posted by atoxyl at 9:54 PM on December 14, 2022 [5 favorites]
In my understanding - can’t give citations here, this is a little bit of a “hanging out in the right places to see things come together” thing - the beginnings of the current fentanyl era are actually somewhat tied to the dark web and the “research chemical” scene. Back in the 90s and 00s “RCs” were mostly psychedelics, but towards the late 00s there was a huge boom in grey market stimulants (most famously mephedrone and the whole family of “bath salts”) synthetic cannabinoids (spice) etc. sold over the internet, and then in gas stations and head shops and the like. In this boom era, the drugs were mostly sourced from Chinese chemical companies that were happy to whip up a batch of whatever without asking too many questions, and resold by various vendors. Inevitably some people realized they could take advantage of this globalized on-demand designer drug infrastructure that had been built up to order fentanyl derivatives, worth a hundred times their weight in heroin and (presumably) get rich.
China eventually cracked down on direct manufacture and sale of synthetic opioids, while continuing to turn somewhat of a blind eye to precursors, and meanwhile the advantages of fentanyl as a product didn’t escape the notice of the Latin American cartels, so eventually the ecosystem shifted to one in which the cartels buy the precursors, make the drugs, and smuggle them for sale the traditional way. And also meanwhile the U.S. cracked down hard on prescription pills, use of which had been creeping up for two decades at that point, and illicit fentanyl use and overdoses took off in a matter of a few years.
posted by atoxyl at 9:54 PM on December 14, 2022 [5 favorites]
Someone in my peripheral social network died of fentanyl overdose from an unfortunate coke purchase. The best theory I’ve ever heard about why coke would be cut with fentanyl is accidental cross-contamination, but this has never made any sense to me. There’s something more there, but I don’t know what it is.
posted by sjswitzer at 10:01 PM on December 14, 2022 [1 favorite]
posted by sjswitzer at 10:01 PM on December 14, 2022 [1 favorite]
There are plenty of people in the US who would like homeless people to just go away.
So far I haven’t seen any evidence of or rumors about a conspiracy to kill inconvenient people by putting fatal doses of fentanyl into illicit opioids, but I would be reassured to know that law enforcement at all levels was alert to the possibility that it could happen, and was using statistical tools and intelligence sources to detect such conspiracies if they did happen to exist, but I haven’t heard of anything like that either.
posted by jamjam at 10:04 PM on December 14, 2022 [1 favorite]
So far I haven’t seen any evidence of or rumors about a conspiracy to kill inconvenient people by putting fatal doses of fentanyl into illicit opioids, but I would be reassured to know that law enforcement at all levels was alert to the possibility that it could happen, and was using statistical tools and intelligence sources to detect such conspiracies if they did happen to exist, but I haven’t heard of anything like that either.
posted by jamjam at 10:04 PM on December 14, 2022 [1 favorite]
the blue-green “M30” pills, available everywhere - which are modeled on one of the classic generics for 30mg oxycodone, but which are nowadays 99 percent of the time mass-produced fentanyl pills
Yeah, except in NZ the m30 pills might be etonitazepyne not fentanyl.
User report: "had me completely fucked up for 8 hours, puked a shit ton, nothing like any other opiate I've ever taken"
It's very simple - if you crack down on supply of one drug, then illict chemists will just make other, more dangerous drugs. Crack down on heroin, get fentanyl. Crack down on fentanyl, get fentanyl analogues. Crack down on fent analogues, get xylazene. Crack down on xylazene, get nitazenes.
Legalising it is the only way to control supply and stop people from dying of whatever random drug is being cooked up right now.
(Just to be up front, I work for a licensed drug checking service. Fully legal and publicly funded. Aotearoa leading the world again.)
posted by happyinmotion at 10:39 PM on December 14, 2022 [12 favorites]
Yeah, except in NZ the m30 pills might be etonitazepyne not fentanyl.
User report: "had me completely fucked up for 8 hours, puked a shit ton, nothing like any other opiate I've ever taken"
It's very simple - if you crack down on supply of one drug, then illict chemists will just make other, more dangerous drugs. Crack down on heroin, get fentanyl. Crack down on fentanyl, get fentanyl analogues. Crack down on fent analogues, get xylazene. Crack down on xylazene, get nitazenes.
Legalising it is the only way to control supply and stop people from dying of whatever random drug is being cooked up right now.
(Just to be up front, I work for a licensed drug checking service. Fully legal and publicly funded. Aotearoa leading the world again.)
posted by happyinmotion at 10:39 PM on December 14, 2022 [12 favorites]
The fentanyl problem may well be one of the biggest own goals we have yet seen in the crusade against drugs. When diversion of legitimate pharmaceuticals was easy, they were everywhere and reasonably cheap. Yeah, some shitheads were getting rich off them and there was some amount of death due to relapse overdoses and such, but everyone knew exactly what they were selling and what they were getting since it all came from the same FDA-regulated factories.
Combine the increasingly difficult task of getting legit pills with the difficulty of accessing treatment due to both expense and unavailability in many places and well, here you are. People switched to heroin which is now not heroin because withdrawals suck. Not only is it deeply unpleasant if you've been a long time user, but it takes long enough to not be shitting yourself and wanting to cut your limbs off that you've probably lost your job by the end of it.
We hardly could have done worse if we tried. Sadly, acting out of anger rarely works out well for anyone, this situation just being one particularly glaring example. It was obvious what was going to happen, but public outrage at what now looks like a relatively small overdose problem along with grandstanding politicians and headline grabbing prosecutors weren't at all interested in listening long enough to grasp the necessity of making maintenance therapy easier and cheaper to access before cutting off the supply.
posted by wierdo at 2:04 AM on December 15, 2022 [10 favorites]
Combine the increasingly difficult task of getting legit pills with the difficulty of accessing treatment due to both expense and unavailability in many places and well, here you are. People switched to heroin which is now not heroin because withdrawals suck. Not only is it deeply unpleasant if you've been a long time user, but it takes long enough to not be shitting yourself and wanting to cut your limbs off that you've probably lost your job by the end of it.
We hardly could have done worse if we tried. Sadly, acting out of anger rarely works out well for anyone, this situation just being one particularly glaring example. It was obvious what was going to happen, but public outrage at what now looks like a relatively small overdose problem along with grandstanding politicians and headline grabbing prosecutors weren't at all interested in listening long enough to grasp the necessity of making maintenance therapy easier and cheaper to access before cutting off the supply.
posted by wierdo at 2:04 AM on December 15, 2022 [10 favorites]
Upon further reflection, it should be noted that cars directly kill tens of thousands of people, injure hundreds of thousands, and result in billions of dollars wasted on property damage annually (not even getting into the indirect death and health impacts caused by emissions) yet there is no mass movement calling for the heads of auto executives.
Instead, we work toward slowly, with fits and starts and occasional backsliding, making them less deadly. We don't just suddenly upend the lives of everyone who drives despite there being other ways to get around. Even when we lose friends and family to cars, few people go on a crusade against them. Most either write it off as an unfortunate incident more akin to a natural disaster or advocate for harm reduction. What's so different about drugs?
posted by wierdo at 2:15 AM on December 15, 2022 [7 favorites]
Instead, we work toward slowly, with fits and starts and occasional backsliding, making them less deadly. We don't just suddenly upend the lives of everyone who drives despite there being other ways to get around. Even when we lose friends and family to cars, few people go on a crusade against them. Most either write it off as an unfortunate incident more akin to a natural disaster or advocate for harm reduction. What's so different about drugs?
posted by wierdo at 2:15 AM on December 15, 2022 [7 favorites]
I am in the rooms. The number of people I know who went back out during the pandemic enforced seclusion and died is too stark a number, and is heartbreaking.
Which is why I don't particularly like this being labeled as Fentanyl OD. It is Fentanyl poisoning, to my mind. Most of them thought they were getting the 'pure' stuff, but unfortunately got the adulterated stuff. OD at one level points to overconsumption: whether it is alcohol or drugs. This is more akin to being poisoned, intentional or otherwise.
posted by indianbadger1 at 9:08 AM on December 15, 2022 [7 favorites]
Which is why I don't particularly like this being labeled as Fentanyl OD. It is Fentanyl poisoning, to my mind. Most of them thought they were getting the 'pure' stuff, but unfortunately got the adulterated stuff. OD at one level points to overconsumption: whether it is alcohol or drugs. This is more akin to being poisoned, intentional or otherwise.
posted by indianbadger1 at 9:08 AM on December 15, 2022 [7 favorites]
So I'm a family doc and I've spent the last ten years doing addiction & HIV medicine out of a syringe exchange in a large city on the east coast. Fentanyl has been the predominant street-obtained opioid for several years here, often combined with xylazine (cf: 2022 Q3 drug checking report). Expect this to spread much more widely.
It's a wicked mess, and after the day I've just had in clinic I'm too emotionally raw and burnt out to provide anything resembling a reassuring narrative. Please consider the following:
My patients aren't fools, and they don't lack insight that fentanyl could kill them as it has so many of their friends and family members. While some in my field call them "deaths of despair," I fear that this characterization robs my patients of their political power by sentimentalizing and personalizing what might otherwise be considered a political kind of suffering. In their refusal to pretend that the city's promises of housing and treatment are anything other than a cruel joke, I try to preserve myself form my own despair through the belief that they are exercising a revolutionary kind of destituent power, albeit a power for which the city would rather watch them die under bridges than recognize.
posted by Richard Saunders at 3:58 PM on December 15, 2022 [79 favorites]
It's a wicked mess, and after the day I've just had in clinic I'm too emotionally raw and burnt out to provide anything resembling a reassuring narrative. Please consider the following:
- Ten years ago, about 25k people per year were dying of opioid overdose. A decade of tighter prescribing has only resulted in a near quadrupling of the opioid overdose death rate. While fentanyl is obviously implicated, the wider concept at work is the Iron Law of Prohibition, through which interdiction efforts have only made the drug supply more unreliable and therefore more dangerous. Without ending prohibition & the war on drugs, I do not see deaths returning to ~25k/y.
- Despite a decade of work to increase access to treatment, 87% of people with opioid use disorder DON'T receive adequate treatment. Because there aren't enough prescribers in the country to bridge that gap, buprenorphine should be available without a prescription, methadone should be massively deregulated (even NIDA director Volkow agrees with me on that point), and buyers clubs similar to the Drug User Liberation Front's model should be implemented to keep the supply safe for those not ready to enter recovery.
- Three quarters of injection drug use can be explained by exposure to adverse childhood experiences. Adopting this sociorelational understanding of substance use disorder is critical to fixing this mess. Yes, let's take Purdue and the rest of them for all they're worth, but if we don't stop the trauma machine our problems will only be compounded.
My patients aren't fools, and they don't lack insight that fentanyl could kill them as it has so many of their friends and family members. While some in my field call them "deaths of despair," I fear that this characterization robs my patients of their political power by sentimentalizing and personalizing what might otherwise be considered a political kind of suffering. In their refusal to pretend that the city's promises of housing and treatment are anything other than a cruel joke, I try to preserve myself form my own despair through the belief that they are exercising a revolutionary kind of destituent power, albeit a power for which the city would rather watch them die under bridges than recognize.
posted by Richard Saunders at 3:58 PM on December 15, 2022 [79 favorites]
Oregon de facto legalized possession of nearly all drugs, and the result hasn't been good. We've seen fentanyl overdoses double.
Legalizing drugs isn't as simple as just legalizing drugs. There needs to be a whole infrastructure put in place to help people struggling with addiction. In Oregon, it feels like we did the first part, but not the second. The results have been devastating.
posted by elwoodwiles at 4:06 PM on December 15, 2022 [4 favorites]
Legalizing drugs isn't as simple as just legalizing drugs. There needs to be a whole infrastructure put in place to help people struggling with addiction. In Oregon, it feels like we did the first part, but not the second. The results have been devastating.
posted by elwoodwiles at 4:06 PM on December 15, 2022 [4 favorites]
Whenever there's an article about fentanyl, I'm always amused by how quickly fingers are pointed at Chinese and Latin people, and how seldom the Sacklers or Oxycontin are mentioned.
Fentanyl likely would not have been such an issue if not for the Sacklers and the corruption of regulators in DC. The Sacklers' drug-dealing helped them become one of the wealthiest families in America, and they were punished with a slap on the wrist.
How lucky they are that there are non-whites to scapegoat now too. It's definitely easier for Americans to blame their woes on foreigners than their elites.
From Patrick Radden Keefe's excellent book, "Empire of Pain: The Secret History of the Sackler Dynasty":
"Even the boom in illicit fentanyl, like the rise in heroin before it was driven by demand considerations existing years prior to the entry of fentanyl. Synthetic opioid abuse was disproportionately high in states that had high rates of oxycontin misuse."
posted by Borborygmus at 5:13 PM on December 15, 2022 [7 favorites]
Fentanyl likely would not have been such an issue if not for the Sacklers and the corruption of regulators in DC. The Sacklers' drug-dealing helped them become one of the wealthiest families in America, and they were punished with a slap on the wrist.
How lucky they are that there are non-whites to scapegoat now too. It's definitely easier for Americans to blame their woes on foreigners than their elites.
From Patrick Radden Keefe's excellent book, "Empire of Pain: The Secret History of the Sackler Dynasty":
"Even the boom in illicit fentanyl, like the rise in heroin before it was driven by demand considerations existing years prior to the entry of fentanyl. Synthetic opioid abuse was disproportionately high in states that had high rates of oxycontin misuse."
posted by Borborygmus at 5:13 PM on December 15, 2022 [7 favorites]
Oregon de facto legalized possession of nearly all drugs, and the result hasn't been good. We've seen fentanyl overdoses double.
Well, Oregon doesn't control the DEA. Unfortunately the opiate crisis is a national-level issue. States can certainly do things to help, but it's likely to be tinkering around the bounds of the issue. It's the FDA and DEA that have the real levers of power over the supply.
The sad part is that you can be an opiate user and be a totally responsible, functioning member of society for a long time. There are lots of examples of people who, by virtue of having enough money and connections, have used heroin or other opiates for years, even decades, without it being particularly obvious outside their immediate circle. In my limited experience, an alcohol addiction will kill you faster and more obviously than an opiate addiction, if you have an equivalently clean supply of both.
I'm always amused by how quickly fingers are pointed at Chinese and Latin people, and how seldom the Sacklers or Oxycontin are mentioned.
I don't think we're reading the same sources, then. Most people I know are very aware of the connection between the Sacklers and Oxy. But, yeah, they're difficult and slippery to go after, because they're so fucking rich. I'm honestly a little surprised that nobody who's lost a bunch of loved ones to bad "oxy" hasn't shown up at their mansion with some firearms and a Semtex vest and blown them all to hell. The courts certainly do not have a monopoly on justice in our age, if they ever have.
But while it's fair to go after the Sacklers for pushing Oxy as "non-addictive" and enabling shady pill-mill clinics, Oxycodone itself isn't a bad drug. If you understand the risks, it's pretty damn effective, and people who are in pain need better analgesic drugs. At least in my experience, most of the deaths associated with Oxycodone didn't happen to people when they were able to get real-deal prescription Oxy from the pharmacy; that's perhaps when they got dependent, but the stuff isn't poison. It's when they suddenly got cut off from the legitimate supply that people tend to turn to black-market alternatives, and it's those "alternatives" that are super dangerous and sometimes no better than poison, because the potency is so variable. One bad batch of fentanyl-laced (or fentanyl + filler) "heroin" could burn through a town in a matter of days, leaving a pile of bodies in its wake, and generally the people who I saw end up dead weren't current Oxy users, but former ones who had run out of legitimate ways to get it. They didn't have a safe off-ramp from opiates, and we still don't really have one for them.
posted by Kadin2048 at 11:54 AM on December 16, 2022 [6 favorites]
Well, Oregon doesn't control the DEA. Unfortunately the opiate crisis is a national-level issue. States can certainly do things to help, but it's likely to be tinkering around the bounds of the issue. It's the FDA and DEA that have the real levers of power over the supply.
The sad part is that you can be an opiate user and be a totally responsible, functioning member of society for a long time. There are lots of examples of people who, by virtue of having enough money and connections, have used heroin or other opiates for years, even decades, without it being particularly obvious outside their immediate circle. In my limited experience, an alcohol addiction will kill you faster and more obviously than an opiate addiction, if you have an equivalently clean supply of both.
I'm always amused by how quickly fingers are pointed at Chinese and Latin people, and how seldom the Sacklers or Oxycontin are mentioned.
I don't think we're reading the same sources, then. Most people I know are very aware of the connection between the Sacklers and Oxy. But, yeah, they're difficult and slippery to go after, because they're so fucking rich. I'm honestly a little surprised that nobody who's lost a bunch of loved ones to bad "oxy" hasn't shown up at their mansion with some firearms and a Semtex vest and blown them all to hell. The courts certainly do not have a monopoly on justice in our age, if they ever have.
But while it's fair to go after the Sacklers for pushing Oxy as "non-addictive" and enabling shady pill-mill clinics, Oxycodone itself isn't a bad drug. If you understand the risks, it's pretty damn effective, and people who are in pain need better analgesic drugs. At least in my experience, most of the deaths associated with Oxycodone didn't happen to people when they were able to get real-deal prescription Oxy from the pharmacy; that's perhaps when they got dependent, but the stuff isn't poison. It's when they suddenly got cut off from the legitimate supply that people tend to turn to black-market alternatives, and it's those "alternatives" that are super dangerous and sometimes no better than poison, because the potency is so variable. One bad batch of fentanyl-laced (or fentanyl + filler) "heroin" could burn through a town in a matter of days, leaving a pile of bodies in its wake, and generally the people who I saw end up dead weren't current Oxy users, but former ones who had run out of legitimate ways to get it. They didn't have a safe off-ramp from opiates, and we still don't really have one for them.
posted by Kadin2048 at 11:54 AM on December 16, 2022 [6 favorites]
Oregon de facto legalized possession of nearly all drugs, and the result hasn't been good. We've seen fentanyl overdoses double.
Maybe I'm missing something here, but that sounds substantially the same as the 94% increase reported nationwide in the OP. Which suggests that decriminalization indeed doesn't improve things, but also that it doesn't make them much worse (perhaps because as noted above state-level policy is going to have a pretty limited impact).
posted by Not A Thing at 1:40 PM on December 16, 2022 [5 favorites]
Maybe I'm missing something here, but that sounds substantially the same as the 94% increase reported nationwide in the OP. Which suggests that decriminalization indeed doesn't improve things, but also that it doesn't make them much worse (perhaps because as noted above state-level policy is going to have a pretty limited impact).
posted by Not A Thing at 1:40 PM on December 16, 2022 [5 favorites]
and there was some amount of death
If it was only "some" amount, or "relatively small" per your later comment, why is there so much fury at the Sacklers?
posted by pelvicsorcery at 9:33 AM on December 17, 2022
If it was only "some" amount, or "relatively small" per your later comment, why is there so much fury at the Sacklers?
posted by pelvicsorcery at 9:33 AM on December 17, 2022
I described it that way because it pales in comparison to what that fury brought about. We forged ahead despite the warnings of experts and now four times as many people are dying.
posted by wierdo at 11:28 AM on December 17, 2022 [2 favorites]
posted by wierdo at 11:28 AM on December 17, 2022 [2 favorites]
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